CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 35 70.000000 3500.0000 50.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
NUTR-97802-NUTRITIONAL EVAL, INITIAL 12 67.000000 3350.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 13 112.000000 5600.0000 50.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 3.000000 174.3300 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 14 145.000000 8425.9500 58.1100
Subtotal (Total Children Is Unduplicated) 74 409.000000 21892.0600 53.5258
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 134 250.750000 12512.5000 49.9003
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 2.000000 100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 39 54.500000 1362.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 13.000000 700.0000 53.8462
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 6.000000 300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.000000 150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 247 1536.000000 82944.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 521 4269.000000 29529.0000 6.9171
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 116 775.000000 9204.0000 11.8761
OCCT-97530-OT SESSION BY LICENSED OT 43 207.000000 16833.2400 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 8.750000 711.5500 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 12 71.000000 4102.5600 57.7825
PHY-97110-PT SESSION BY LICENSED PT 61 355.500000 28612.2000 80.4844
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 130.2400 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 1.000000 65.1200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 85 468.000000 37407.2000 79.9299
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 15.000000 1219.8000 81.3200
TRAV-TRAVS-Travel by mile 688 74893.00000 33298.1200 0.4446
Subtotal (Total Children Is Unduplicated) 730 82936.50000 259411.0300 3.1278
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Total 83345.500000 281303.0900 3.3751
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Number of Children (Unduplicated) With at Least One Service 739
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Center 09
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 10878 65737.750000 200795.3600 200795.3600
D 71 238.000000 2431.6300 0.0000
S 91 265.000000 1877.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1794 8110.500000 40502.9300 40502.9300
1645 8990.250000 35414.1200 0.0000
Other 2 4.000000 281.8000 0.0000
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Total 14481 83345.500000 281303.0900 241298.2900